Health insurance provider Cigna is accused of policies that discriminate against patients with HIV, including exorbitant copays and mandatory mail-order policies.
Last month, Cigna agreed to drop its mail order requirement in a settlement and withdrew from Florida’s insurance exchange.
HIV treatment drugs, including generics, are grouped in the high tiers of cost-sharing at up to a 40 percent copay.
The Florida Office of Insurance Regulation (FLOIR) investigated Cigna and three other providers (Aetna, Humana and Preferred) and instituted an agreement capping copay for plans on the state’s insurance exchange at $200 for four common prescriptions effective as of open enrollment in 2015.
Cigna recently announced it will not be participating in the Affordable Care Act exchange in Florida in 2016, citing abuse and an inability to alter plans with the exchange in time to meet deadlines. However, the provider did announce its intention to return to the marketplace in 2017.
“It’s a good sign that Cigna is returning in 2017,” Florida-based AIDS institute Deputy Executive Director Carl Schmid told Patient Daily.
Cigna’s withdrawal from the insurance exchange, while not attributed to the FLOIR decision, did mean the provider will not be required to lower copays in 2016. However, their statement that they intend to return to the exchange indicates that they will be part of the agreement in 2017 upon their return.
Cigna’s initial agreement with FLOIR only pertained to the Florida insurance market and does not settle a federal discrimination complaint against the provider. Cigna also did not admit any wrongdoing.
“We’ve made progress in Florida,” Schmid said. “Other states still may be dealing with these practices.”
As for why HIV patients have allegedly faced such strong discrimination from Cigna and others, Schmid said that the lifetime costs of patients with HIV are rather high compared to healthy customers, but that this is not exclusively a problem faced by HIV patients.
“I can’t say it’s just HIV,” said Schmid, “Chronic conditions face discrimination.”
However, Schmid said, insurance providers receive federal money for patients who have chronic conditions that are on their rosters. This funding, though not well advertised, is designed to combat exactly the type of discrimination Cigna and other providers are being accused of perpetrating.
The AIDS Institute said the complaints being filed against providers for these practices have had a significant positive impact, especially in light of the agreements reached by FLOIR. The AIDS Institute suggests other states follow a similar approach to mimic Florida’s success.